1. Field of the Invention
The present invention relates to systems for coordinating the use of a high valued facility among many persons, and in particular to measuring conditions and deriving availability parameters without human intervention for integrated display, such as on a magnetic whiteboard with manually entered information.
2. Description of the Related Art
Hospital operating rooms (ORs) are valuable facilities. It has been estimated that in typical hospitals, the operating rooms account for about 40% to about 50% of revenue from patients. The operating rooms also account for a large share of the hospital resources and expenses. It is in the interest of the hospital administrators to make maximum use of the operating rooms in their hospital, such as by minimizing the time from the exit of one patient to the entry of the next patient. However, the use of each operating room in the hospital requires the coordinated efforts of a large number of persons or teams of persons, including for example, surgeons, anesthesiologists, surgical assistants, charge nurses, cleaning staff, equipment maintenance staff, and runners who bring patients and supplies into and out of the operating room. Each person or team must often complete the person's or team's own task before another person or team can use the facility.
For example, after a procedure on a patient is completed, the following sample actions may take place in sequence: the patient is prepared for removal by anesthesiologists and nurses, for example by disconnecting the patient from anesthesia delivery equipment and covering the patient; the patient is removed from the operating room by an anesthesia care provider; and the operating room and its operating table are cleaned by cleaning staff. Before the next procedure can begin, the following sample actions may take place in sequence: the cleaned operating room and table are prepared for the next patient by OR nurses and technicians; equipment and tools to be used in the next procedure are brought in, serviced or repaired by equipment maintenance staff; supplies are replenished by support staff; the next patient is brought in and transferred to the operating room table by nurses and anesthesia care providers; and the next patient is prepared for the procedure, for example, by receiving anesthesia from an anesthesiologist and by being connected to a fixed or mobile heart and blood oxygen level monitoring equipment by a OR nurse. Only then may the surgeon begin the next procedure. Charge nurses for surgical operating rooms connect multiple people, resources, and patients to ensure efficient and safe operation of the operating room. The various persons, alone or in teams, are often standing by—ready to act when the room or patient is in a state to be acted upon.
The sequencing of actions by these personnel would be relatively easy to plan and execute if all procedures in an operating room were predictable with certainty. However, procedures performed in operating rooms can deviate in both number and temporal duration substantially from average or planned use. In contrast to most operating rooms, day-of-surgery case scheduling in a trauma center is especially dynamic. Much of the decisions on surgical case scheduling in trauma centers are made on the day of surgery, whereas in most other operating rooms the scheduling is usually determined days in advance. In either case, persons who act in the operating room are unable to determine exactly when their services are required. As a consequence, resources are wasted as person wait idly by for an operating room that is not ready for their activity, or are occupied in another operating room or area when their action is required next in a different operating room. For example, if a procedure finishes half an hour early, a doctor en route for the next operation expected to start at 10 AM may be unavailable when the room is ready. Thus valuable minutes of operating room availability are lost.
A charge nurse takes requests for surgery and translates them into a schedule of specific times or sequences, or both, in each of the individual operating rooms (e.g., six operating rooms in an illustrated example). If a case is not scheduled as the first case, its starting time cannot be accurately scheduled. The order of the case is then scheduled “to follow” the first case for the respective operating room. Charge nurses are attired in “scrubs” (sterile gloves and gown) typically to go inside the operating rooms. They do not have clinical duties ordinarily, although they often have extensive clinical experience working in the operating rooms. The charge nurses are mobile during their shift and do walk around; but the charge nurses primarily remain in the vicinity of a control desk typically located in or near a corridor through which surgical patients are brought in.
Examples of changes affecting the planned surgery schedule include cancelled surgeries; unexpected additional surgeries (which result from both newly admitted patients as well as deterioration of previously admitted patients necessitating re-visits to an operating room); multi-patient trauma situations in which demand exceeds resource supply, at least temporarily; and any external variables impacting operating room operational status (unavailable or malfunctioning equipment, lack of supplies, and changes in staffing patterns, such as caused by illness, attrition, and hiring delays).
Based on reports of patient exit from an operating room and next patient entry into the operating room, operating room use efficiency can be measured and compared. One measure of operating room (OR) efficiency is the percentage of operations that start on time—so called “on-time OR starts.” The industry average for on-time OR starts is 27%. The best performing operating rooms have on-time OR starts of 76%. Clearly, there is room for improvement at all hospitals.
In one approach, employed for a suite of operating rooms that exhibit good performance, the charge nurses use a large whiteboard (365×122 cm) in front of the control desk. The whiteboard is used in part to show surgical schedules. Different portions of the whiteboard are devoted to different operating rooms. A magnetic strip with case information is prepared for every case scheduled for the suite of operating rooms. The magnetic strips are arranged or updated to indicate the current status of the case, including the operating room where the case is to be handled and the sequence of the cases in that operating room and the state of readiness of the patient associated with the case. Other details can be written into the spaces on the whiteboard or the magnetic strips with markers, or typed or written on papers taped to the whiteboard. Magnetic strips or tokens are also prepared for various staff and positioned on the whiteboard according to their availability and assignment.
While providing a useful place for recording and exchanging information about the use of the operating rooms, the whiteboard has some shortcomings. Updating the whiteboard requires human interaction. Thus the whiteboard is subject to failures when information is not provided by the human users. For example, a human might not report new information due to forgetfulness; distraction by personal, emotional or urgent events; physical separation from the whiteboard; or motivation to delay reporting information (for example, to prevent the early termination of a rest break or meal break or to delay reporting an unusual absence by a favored coworker).
In another approach, video cameras and microphones were installed in surgical operating rooms to relay audio and video to remotely situated neurophysiologists. Prior to this approach, those neurophysiologists could access patient monitoring data remotely. With the addition of audio and video, the neurophysiologists could monitor the patient better by the supplemental audio and video information about the progress of a surgery and estimate when a procedure might likely be completed. Additionally, neurophysiologists could schedule their tasks better by utilizing low-workload periods better.
While improving the availability of information about the current use of a facility, the approach of transmitting video and audio was found to raise serious privacy issues, such as casual conversations in operating rooms being overheard by those remotely situated. In particular, participants were inhibited by the possibility of their work activities being broadcast to unseen and unknown observers.
Furthermore, while experienced neurophysiologists could determine a stage of a procedure by observing the video and audio data, other personnel using the facility were not appraised of the progress of the procedure or warned when a procedure was completed or a patient was being prepared for removal or given estimates of when their next action would likely be required. Thus other personnel still had to guess when they should report for their next action, wasting resources when they guessed incorrectly.
Clearly there is a need for a system to share status and availability information about operating rooms that does not suffer the disadvantages of previous approaches, such as subjective updating, loss of privacy and discretion, and lack of predictions for the time of subsequent actions for all concerned staff, among other deficiencies.
In general, there is a need for a system to share status and availability information about other high value facilities that are used by multiple persons in a coordinated interaction that does not suffer the disadvantages of previous approaches.